Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 25MA10631800 | NJ |
NPI | 1073761375 |
---|---|
Provider Name | Dr. Corey Michael Mossop |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 01/10/2019 |